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Visual and Cognitive Deficits Predict Stopping or Restricting Driving: The Salisbury Eye Evaluation Driving Study (SEEDS)

¹From the Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, the ³Lions Low Vision Center, the ⁴Department of Psychiatry and Behavioral Sciences, and the ⁵Applied Physics Laboratory, The Johns Hopkins University, Baltimore, Maryland; and the ²George Institute for International Health, University of Sydney, Sydney, Australia.

PURPOSE. To determine the visual and other factors that predict stopping or restricting driving in older drivers.

METHODS. A group of 1425 licensed drivers aged 67 to 87 years, who were residents of greater Salisbury, participated. At 1 year after enrollment, this group was categorized into those who had stopped driving, drove only within their neighborhood, or continued to drive beyond their neighborhood. At baseline, a battery of structured questionnaires, vision, and cognitive tests were administered. Multivariate analysis determined the factors predictive of stopping or restricting driving 12 months later.

RESULTS. Of the 1425 enrolled, 1237 (87%) were followed up at 1 year. Excluding those who were already limiting their driving at baseline (n = 35), 1.5% (18/1202) had stopped and 3.4% (41/1202) had restricted their driving. The women (odds ratio [OR], 4.01; 95% confidence interval [CI], 2.05–8.20) and those who prefer to be driven (OR, 3.91; 95% CI, 1.91–8.00) were more likely to stop or restrict driving. Depressive symptoms increased likelihood of restricting or stopping driving (OR, 1.08; 95% CI, 1.009–1.16 per point Geriatric Depression Scale). Slow visual scanning and psychomotor speed (Trail Making Test, Part A: OR, 1.02; 95% CI, 1.01–1.03), poor visuoconstructional skills (Beery-Buktenica Test of Visual Motor Integration: OR, 1.14; 95% CI, 1.05–1.25), and reduced contrast sensitivity (OR, 1.15; 95% CI, 1.03–1.28) predicted stopping or reducing driving. Visual field loss and visual attention were not associated. The effect of vision on changing driving behavior was partially mediated by cognition, depression, and baseline driving preferences.

CONCLUSIONS. In this cohort, contrast sensitivity and cognitive function were independently associated with incident cessation or restriction of driving space. These data suggest drivers with functional deficits make difficult decisions to restrict or stop driving.

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